July 11, 2018

expert reaction to Thai school children rescued from cave

The Thai school children and their football coach, who were trapped in a cave in Thailand, have now been rescued.

Dr Andrea Danese, Head of the Stress & Development Lab the Institute of Psychiatry, Psychology & Neuroscience, King’s College London, and Consultant Child & Adolescent Psychiatrist at the South London & Maudsley NHS Foundation Trust, said:

“Claim back life: Once medically cleared, the boy will need to be reunited with their families. The boys need to go back to their normal life, to their daily routines, in order to fully appreciate that the threat is over.

“Talking about trauma: Parents / carers should let the boys talk about their ordeal, if they wish to. This may help their recovery by letting them build their own narrative of the events and by understanding that it is unlikely that the same events will happen again. Their narrative may highlight unhelpful cognitions (e.g. guilt) that would need to be addressed in order to reduce risk for later psychopathology. However, the boys should not be forced to talk, if they do not wish to. This is because forcing the boys to talk about the events unwillingly could trigger distressing memories and precipitate psychopathology. The media attention probably cannot be avoided but will need to be carefully managed.

“Assessment: The boys may have emotional symptoms, for example, they can remain anxious after their ordeal, they may have trouble sleeping, they may be irritable. Based on research from my team [King’s College London –  Stress & Development Lab](https://www.kcl.ac.uk/ioppn/depts/cap/research/stress-and-development-lab/stress-and-development-lab.aspx) and others, I would expect  10-20% of the boys may develop longer-term psychiatric disorders, such as depression, anxiety, post-traumatic stress disorder, or possible conduct problems and substance abuse. Therefore, the boys should be carefully assessed and monitored over time after being reunited with their families. The assessment needs to be broad, considering all types of psychopathology rather than only focusing on PTSD, should include a careful assessment of their risk for self-harm, and identify changes in functioning since the incident. Some children may have had pre-existing vulnerability to psychopathology, which should be considered in the assessment.

“Treatment: It is important that the boys who do develop psychopathology receive evidence-based treatments personalised to their clinical presentation rather than general counselling on copying with distress or interventions with poor evidence base. For example, the boys may develop post-traumatic stress disorder (PTSD). The key evidence-based treatment for PTSD used in our clinic [Anxiety and Traumatic Stress Clinic |  SLaM National Services](https://www.national.slam.nhs.uk/services/camhs/anxiety-traumatic-stress-clinic/) and endorsed in all guidelines is a form of talking therapy called Trauma-focused Cognitive Behavioural Therapy. Others might need more intensive treatment including psychiatric medications. Briefly, in addition to providing skills to reduce distress and strong emotions, it involves psycho-education about the symptoms, addressing unhelpful cognition around the event (e.g., guilt), building a narrative of the event, and in-vivo behavioural experiments that teach the children how to cope with trauma reminders (e.g., darkness, water).”

Declared interests

None received.